Provider Demographics
NPI:1386868032
Name:IRON COUNTY EMS
Entity Type:Organization
Organization Name:IRON COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SETZER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT PARAMEDIC
Authorized Official - Phone:573-244-5966
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:15 VINE STREET
Mailing Address - City:VIBURNUM
Mailing Address - State:MO
Mailing Address - Zip Code:65566-0331
Mailing Address - Country:US
Mailing Address - Phone:573-244-5966
Mailing Address - Fax:573-244-5959
Practice Address - Street 1:15 VINE STREET
Practice Address - Street 2:
Practice Address - City:VIBURNUM
Practice Address - State:MO
Practice Address - Zip Code:65566
Practice Address - Country:US
Practice Address - Phone:573-244-5966
Practice Address - Fax:573-244-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0930173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800551608Medicaid
MO1386868032Medicaid
MO1386868032Medicaid